Worksheet 2
Case Study (For Modules 6-11, prepared by Mr. Mark Fielding)
Please read the following case study carefully and answer the questions below.
John, a 56-year-old male (174cm, 85.4 kg), presented to the Emergency Department (ED) with a decreased level of consciousness, pale, sweating, and cool peripherally. He had decreased air entry in both bases of his lungs, widespread crackles, and pitting edema in both ankles.
Upon investigation, John’s father Jim tells you John had an extensive myocardial infarction two (2) years ago for which he was admitted to an ICU for three (3) weeks.
John’s observations:
HR 141 bpm Temp 35.4°C
BP 75/59 mmHg SpO2 74 %
RR 38 / minute
Despite non-invasive oxygen therapy, John’s hypoxemia …show more content…
With the left ventricle’s strong pumping action, blood is ejected to the rest of the body via the aorta. When the left ventricle cannot efficiently pump blood out of the ventricle into the systemic circulation, pulmonary venous blood volume and pressure build up, leading to fluid accumulation in the lung instigating left-sided heart failure. Common causes of left-sided failure comprise excessive alcohol intake, history of heart attack leading to poor left-side function, infections in the heart muscle, hypertension, hypothyroidism, heart valves that are narrow or seep out and any other disease that has injured the heart muscle. The clinical manifestations include frothy or blood-tinged cough, bilateral basilar crackles, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, low oxygen saturation, having palpitations, decreased urine output, weakness, fatigue, irregular rapid pulse and weight gain. In children where left-sided heart failure may be caused by heart birth defects, symptoms may include weight loss, poor feeding and failure to …show more content…
40 mg IV Furosemide is a loop diuretic preventing the body from absorbing too much salt, moreover makes the body pass salt via urine. The primary use of furoemide in heart failure is reducing the pulmonary and/ or systemic congestion and edema helping with the dyspnea associated wit h the congestion.
e. Heparin infusion is indicated as patients with heart failure are at greater risk for developing venous thromboembolism, stroke and atrial fibrillation. This anticoagulant therefore is needed and is part of a guideline on the use of thromboprophylaxis for John.
f. ECG and cardiac enzymes (CK, CKMB, Troponin) every six (6) hours. ECG is a test that records the rhythm and electrical conductivity of the heart. Cardiac enzymes are high sensitivity studies that measure the enzymes and proteins linked with heart muscle damage. They are tests done serially to evaluate if damage patterns may be present. According to Dr. Colin Tidy, these enzymes peak earlier after a successful thrombolytic treatment.
g. Aspirin 150 mg NGT daily is needed for immediate anti-clotting effect, limiting the extent of further damage to the heart muscle, preventing further heart
Case Study (For Modules 6-11, prepared by Mr. Mark Fielding)
Please read the following case study carefully and answer the questions below.
John, a 56-year-old male (174cm, 85.4 kg), presented to the Emergency Department (ED) with a decreased level of consciousness, pale, sweating, and cool peripherally. He had decreased air entry in both bases of his lungs, widespread crackles, and pitting edema in both ankles.
Upon investigation, John’s father Jim tells you John had an extensive myocardial infarction two (2) years ago for which he was admitted to an ICU for three (3) weeks.
John’s observations:
HR 141 bpm Temp 35.4°C
BP 75/59 mmHg SpO2 74 %
RR 38 / minute
Despite non-invasive oxygen therapy, John’s hypoxemia …show more content…
With the left ventricle’s strong pumping action, blood is ejected to the rest of the body via the aorta. When the left ventricle cannot efficiently pump blood out of the ventricle into the systemic circulation, pulmonary venous blood volume and pressure build up, leading to fluid accumulation in the lung instigating left-sided heart failure. Common causes of left-sided failure comprise excessive alcohol intake, history of heart attack leading to poor left-side function, infections in the heart muscle, hypertension, hypothyroidism, heart valves that are narrow or seep out and any other disease that has injured the heart muscle. The clinical manifestations include frothy or blood-tinged cough, bilateral basilar crackles, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, low oxygen saturation, having palpitations, decreased urine output, weakness, fatigue, irregular rapid pulse and weight gain. In children where left-sided heart failure may be caused by heart birth defects, symptoms may include weight loss, poor feeding and failure to …show more content…
40 mg IV Furosemide is a loop diuretic preventing the body from absorbing too much salt, moreover makes the body pass salt via urine. The primary use of furoemide in heart failure is reducing the pulmonary and/ or systemic congestion and edema helping with the dyspnea associated wit h the congestion.
e. Heparin infusion is indicated as patients with heart failure are at greater risk for developing venous thromboembolism, stroke and atrial fibrillation. This anticoagulant therefore is needed and is part of a guideline on the use of thromboprophylaxis for John.
f. ECG and cardiac enzymes (CK, CKMB, Troponin) every six (6) hours. ECG is a test that records the rhythm and electrical conductivity of the heart. Cardiac enzymes are high sensitivity studies that measure the enzymes and proteins linked with heart muscle damage. They are tests done serially to evaluate if damage patterns may be present. According to Dr. Colin Tidy, these enzymes peak earlier after a successful thrombolytic treatment.
g. Aspirin 150 mg NGT daily is needed for immediate anti-clotting effect, limiting the extent of further damage to the heart muscle, preventing further heart